基于Wiberg分型探讨髌骨形态对髌股关节病变病人全膝关节置换术疗效的影响

Effect of Patellar Morphology on Total Knee Arthroplasty in Patients with Patellofemoral Joint Osteoarthrosis Based on Wiberg Classification

目的基于髌骨Wiberg分型探讨不同髌骨形态对于合并髌股关节病变的膝关节骨关节炎病人全膝关节置换术(total knee arthroplasty,TKA)的疗效影响。方法将2018年1月至2022年1月接受初次TKA并符合标准的184例病人作为研究对象,根据病人术前髌骨形态Wiberg分型分为W1(Ⅰ型52例)、W2(Ⅱ型93例)、W3(Ⅲ型39例)三组,随访收集并比较病人手术前后的膝前方疼痛发生率、疼痛视觉模拟量表(VAS)评分、牛津大学膝关节评分(Oxford Knee Score,OKS)、Feller评分以及影像学资料。结果三组病人末次随访时的各项观察指标均较术前明显改善(P<0.05),其中术后12个月随访时,W3组病人术后膝前痛程度和发生率显著高于W1、W2两组;同时W1、W2组的OKS评分中第12题的得分明显优于W3组,W1、W2组的Feller评分明显高于W3组,差异有统计学意义(P<0.05)。结论Wiberg分型为Ⅰ、Ⅱ型髌骨的病人TKA术后的膝前痛程度、发生率以及髌股关节功能的改善情况均优于Ⅲ型病人,而部分磨损过于严重的Ⅲ型病人是否适合TKA需进一步研究。

Objective To investigate the effect of different patellar morphology on the efficacy of total knee arthroplasty(TKA)in knee osteoarthritis patients with patellofemoral joint osteoarthrosis based on patellar Wiberg classification.Methods A total of 184 patients who underwent initial TKA from January 2018 to January 2022 and met the criteria were selected as the study objects.The patients were divided into three groups by Wiberg classification of preoperative patellar morphology:W1(52 cases),W2(93 cases)and W3(39 cases).The incidence of anterior knee pain(AKP),visual analog scale(VAS),Oxford Knee Score(OKS),Feller score and imaging data of patients before and after surgery were collected and compared among the three groups.Results At the last follow⁃up,all the observation indexes of the three groups were significantly improved as compared with those before operation(P<0.05).At 12th month after surgery,the degree and incidence of postoperative AKP in the W3 group were significantly higher than those in the W1 and W2 groups.Meanwhile,OKS Q12 in the W1 and W2 groups was significantly better than that in the W3 group,and Feller scores in the W1 and W2 groups were significantly higher than those in the W3 group(P<0.05).Conclusion The degree of knee pain,the incidence of AKP,and improvement of patellofemoral joint function of patients with Wiberg typeⅠandⅡpatella after TKA surgery are superior to those with Wiberg typeⅢpatella.However,whether some WibergⅢpatients with severe wear are suitable for TKA needs further study.